“All happy families resemble one another, but each unhappy family is unhappy in its own way”
Leo Tolstoy, Anna Karenina
Over the last decade there has been a growing recognition of substance misuse and its impact on the family, rather than as a problem limited to an individual’s own life – for example the Hidden Harm report in 2003, which shone a light for the first time on children affected by parental drug use; the National Treatment Agency’s Supporting and Involving Carers in 2008, which looked at the provision of services for families independently of their relatives; and the 2008 and 2010 Drug Strategies, which both explicitly recognise the effects of substances beyond the individual using them. In particular, two key ideas are now generally accepted where they were unrecognised previously: that the involvement of family members in the treatment of their relatives with addiction problems can enhance positive outcomes; and that family members in these circumstances show symptoms of stress that merit support in their own right.
Just as there is a risk that families escape attention in drug and alcohol policy, there is a corresponding risk that drug and alcohol issues don’t receive enough attention in family policy. Initiatives such as Family Intervention Projects and Think Family have helped to put substance misuse on the radar of family support and social care practitioners, and the language of ‘multiple needs’ has attracted the attention of the higher echelons of Government. It is vital that in the multiplicity of needs – for example antisocial behaviour, domestic violence and low educational attainment - we don’t forget about the impact that drugs and alcohol can have in a family environment.
Whether it be the links between alcohol use and domestic violence, or substance use and mental health issues, for example, social care practitioners have found themselves juggling an increasingly complex mix of factors in pulling together a picture of a family and working effectively with them. Family policy may embrace drugs and alcohol in a general way, but unless this is accompanied by specific responses and practitioner expertise relating to substance use – and we have seen a marked increase in demand for this kind of training from children and family services – it will be difficult for local responses to improve.
The challenges for policy, and for progress, are of definition and location. What exactly does a drug or alcohol misusing family look like and hence, where do we find a ‘home’ for these families in policy and practice? These families have substance misuse problems and hence need to be included in drugs and alcohol policy; however, substance use rarely exists in isolation and these families often come to the attention of wider policy initiatives: they may also be out of work, committing crime, in prison, living in poverty, and subject to physical and mental health problems and domestic violence.
Adfam supports any practitioner working with families affected by substance misuse. Many of the services for these families are set up and run – often on a voluntary basis – by individuals with personal experience of addiction in their own families. These services, among other things, offer peer support and self-help advice, saving the NHS and local authorities £750m, according to the UK Drug Policy Commission - this is the Big Society in practice. However, financial support for these groups, along with many other in the local community sector, is either being withdrawn or shifted into drug and alcohol specialist services, moving the emphasis of care onto the role the family member can play to encourage someone’s recovery rather than focus on the needs of the family in their own right.
So where is the policy compass for these families? The number ofhealth, education, housing, employment, crime and its prevention, plus child protection and safeguarding policy areas searching for the answers to how to deal with these families thus embraces the DfE, the Home Office, The Ministry of Justice, the DWP and the Department of Health. In addition, a major barrier to the effective coordination of work with families affected by substance use is that the term ‘family’ itself is interpreted in so many different ways. For example, from an educational standpoint, the priority may be to support parents in transmitting prevention messages to their children; from a drug policy perspective, it may mean looking at how best to use the family’s expertise to produce better treatment outcomes; or from the point of view of children’s services, the key consideration may be safeguarding the children of substance users from neglect, risk and harm. Adfam was originally set up by the mother of a heroin user who could not find the support she needed in her local area, and it is important that this group – adult family members – are not lost in the concentration on parental substance use.
Despite the best efforts of support services, the family picture is often so complex that it is very difficult for one agency to identify – let alone meet – all their needs. Even if individuals with drug and alcohol problems come into contact with services regularly, the needs of their families and children can remain hidden. For example, drug treatment clients are often reluctant to divulge their parental status for fear that their children will be removed; a family may experience domestic violence and ‘low level’ problem drinking on a daily basis without catching the attention of the authorities; and even in the most severe cases of Serious Case Reviews, 30-40% of the families are not previously known to social care services.
The answer to all this is the joined-up approach. National government and local areas have long been developing protocols and good practice guidance to encourage partnerships between specialist drugs/alcohol commissioning and provision, and children and family – and criminal justice and housing – services. At Adfam we are currently working on some research to see how far this is translated into the everyday practice of those professionals who come into contact with these families. And, to judge from the responses to our training courses focusing on the practice issues for families and children affected by substance use, there is an almost overwhelming need for training from a large and diverse workforce.
What all this means in practice is that policymakers may regard drug and alcohol issues as ‘specialist’ or niche’ as one response, and integral to a myriad of policy areas as another. Nuance is difficult to capture in policymaking, therefore practice suffers a similar fate.
The development of a family-friendly service for families where drug and alcohol misuse may be intergenerational, where parenting capacity is compromised and the life chances of children are negatively affected, should be integral to mainstream practice; nonetheless, it requires a specific skill set and a confident, well-trained workforce to implement effectively.
Investment in providing services and support for families with multiple needs is to be greatly welcomed, and the expansion and positive evaluations of Family Intervention Projects show that this work can be rewarded with positive outcomes which save money in the long-run. Adfam urges consideration to be given to the challenges of engaging and working with these families in the development of the Family Test: service provision for families and children affected by drugs and alcohol is essential.
